Abstract

Institutional care of children is a serious form of physical and psychological neglect that causes impact on many dimensions of child development. Among them, in central nervous system structures and behavioral development. The results suggest that the removal of a child from an institution and its transfer to an improved care environment can lead to a reduced risk of psychopathology, as well as promoting a better social, emotional and cognitive development. It is essential, therefore, the pursuit of a special attention to the implementation of high quality care to minimize possible child and adolescents development deficits.

Keywords

Child development, Institutionalization, Psychopathology

Among the most vulnerable children in the world are those
living outside of family care context, sex trafficking or
pornography victims, trafficked for forced labor and those
recruited into armed conflicts [1]. For more than 80 years,
observational studies have shown severe developmental
delays in nearly every domain among institutionalized
children compared with non-institutionalized controls [2].

It is estimated, therefore, that millions of young in the
planet live under institutional care and in many parts of it,
abandoned or orphaned children are raised in institutions
where care is deprivation of social care [3,4]. In such
contexts, children have an incipient motor, cognitive,
linguistic and social development needed to promote a
typical progress [3]. The magnitude of this problem is
demonstrated by an United Nations International Children's
Emergency Fund (UNICEF) research which estimated that
8 million children are living in institutional settings [4].

In this sense, a research by Berens and Nelson, 2015 and
published in The Lancet shows plenty of evidence about
the impact of institutionalization on biopsychosocial
child development, stressing particular periods of early
childhood that are more sensitive to care deficits and,
furthermore, stating that institutional care has a causal
effect on rates of developmental deficits and delays
[2]. Several studies agree with Nelson’s research, demonstrating problems in several dimensions of child
development.

Memory function is one of the domains that are negatively
influenced by that early deprivation and this also impacts
on specific brain areas such as microstructure of the corpus
callosum body, cingulum, fornix, anterior and superior
corona radiata, external capsule, retrolenticular internal
capsule, and medial lemniscus [3,5].

In addition, children raised in institutionalized settings
showed neuropsychological deficits on tests of visual
memory and attention, as well as visually mediated
learning and inhibitory control and greater willingness to
develop psychopathology [6,7].

In this context, the developmental difficulties
experienced by many of these children raise questions
about the effects of early deprivation including factors
such as failure to provide adequate nutrition, medical
care, stimulation, and the lack of consistent and
supportive caregiving relationships [5]. Therefore,
examination of the effects of deprivation and early
neglect over social, emotional and cognitive functioning
is of practical and theoretical importance [3]. Evidence
suggests that placing children directly in institutional
care as a first line of action, without supporting options for identifying appropriate and protective family care,
is problematic [1].

These trends raise concerns about how societies will
manage the substantial burden of health problems among
previously institutionalized children, because even in
institutions where basic physical needs were met, lack of
individualized care and attention remain prominent [4,5].

Institutionalization seems to have an important impact
on the socio-emotional development of children and
adolescents, as shown by recent results from Humphreys
& colleagues, which showed in a study of 136 children
who have a history of institutional creation was associated
with higher levels of internalizing and psychopathological
manifestation, psychiatric morbidity and disruption of
Attention and Hyperactivity Deficit Disorder (ADHD)
in children 12 years of age compared with a cohort of
children with typical development and who had never
been put in an institution [8]. About this domain of socioemotional
development, studies have largely focused on
documenting unfavourable attachment patterns, which are
believed to be associated with later psychopathology and
behavioural difficulties [2]. This is especially present in
girls because it was found that those who had been through
institutional environments had significantly higher rates of
internalizing (depression and anxiety) than girls who had
never lived in institutions [8].

In this way, institutional care represents an outdated model
of assistance to orphans or victims of abuse. Public policies
should be aimed at promotion of high quality social
assistance throughout childhood and early adolescence. It
assumes the presence of professionals able to use tools that
maximize child development, providing psychosocial and
educational support, such as construction and use of cozy
spaces. In addition, approaches must be used to integrate
the community looking to simulate as closely as possible
the normal environment expected for the development of
a child. To reach that reality, family care programs should
represent important targets of practical research and policy
attention.

Studies point out, also, the need to understand the changes
present in the cerebral white matter of institutionalized
young people and their correlation with the neurocognitive
or psychiatric functioning. This is fundamental, since
understanding the specific trajectories of changes in
white matter may have important contributions to public
health, allowing predict the time, duration and format of
early interventions for children at risk. It is worth noting
that some studies have shown differentiated impacts of
institutionalization between boys and girls, particularly as
they relate to the partners-emotional aspects. Therefore,
gender issues should be taken into account when planning
interventions to this vulnerable part of the population.

Ultimately, deprivation of social assistance in any care
environment early in life can be as damaging as any other
pathology and should be seen by the competent institutions with the same concern for a severely debilitating childhood
disease.

References

Maholmes V, John DF, Richard D, et al. Protecting children outside of family care in low and middle income countries: What does the evidence say? Child Abuse and Neglect 2012; 36: 685-688.

Berens AE, Nelson CA.The science of early adversity: is there a role for large institutions in the care of vulnerable children? The Lancet 2015; 14:61131-61134.